Lesions of the oral maxillofacial region that present as a mass

One of the most common diagnostic clinical problems is the patient who presents for evaluation with a mass in the oral cavity.  Developing a reasonable differential diagnosis of the lesion is the first step in managing such a patient.  The differential diagnosis serves a guide subsequent intervention and, if necessary, provides an appropriate basis for referral of the patient. The majority of these tumors fall into one of two categories.  They are either soft tissue or salivary tumors, including reactive conditions from these groups.  The frequency of such lesions varies from one specific site to another, so the tumor’s specific location is also a consideration in the differential diagnosis.

Differential Diagnosis of Mass Lesions by Site

Lower lip:

  Mucocele

  Fibroma

  Hemangioma

 Squamous cell carcinoma

Upper Lip:

  Fibroma

  Benign salivary gland tumor

  Benign soft tissue tumor(Schwannoma, leiomyoma)

  Squamous cell carcinoma

Buccal Mucosa:

  Fibroma

  Lipoma

  Mucocele

  Hyperplastic lymph node

  Soft tissue tumor

  Squamous cell carcinoma

  Salivary gland tumor

Gingiva:

  Parulis

  Pyogenic Granuloma

  Peripheral Ossifying Fibroma

  Peripheral Giant Cell Granuloma

  Fibrous Hyperplasia 

•       Inflammatory (including epulis fissuratum)
•       Drug related
•       Systemic
•       Soft tissue tumor

  Metastatic tumor

Floor of Mouth:

  Ranula/mucocele

  Sialolithiasis

  Benign lymphoepthelial cyst 

  Squamous cell carcinoma

Tongue:

  Fibroma

  Mucocele (ventral tongue)

  Granular cell tumor

Palate:

  Dental abscess

  Salivary gland tumor

  Nasopalatine duct cyst

  Soft tissue tumor

  Papilloma